KARACHI: For Sindh, intensifying malnutrition has been one of the most pressing issues of late, one for which the provincial government has come under fire many times.
In response, the Sindh government, together with the assistance of international donor agencies, started several multi-billion projects to alleviate the situation. Despite the launch of these projects, even though slight progress was witnessed across the province – especially among young children – overall the situation has worsened in several rural areas, particularly Tharparkar.
“The rates of mortality among newborn and young children in Tharparkar District has almost doubled in 2019 as compared to the last year”, local journalist Khatau Jani told The Express Tribune. “The death ratio among young children was between 300 and 350 in 2018, while it has increased to 692 this year.”
He further said, “The situation in hospitals across the administrative sub-divisions (talukas) of the district is worsening with each passing day. Earlier, the government had announced to set up nutrition wards in each taluka hospital of the Tharparkar District, however, no such wards were established.”
Shedding light on the matter, a member of the executive committee of Pakistan Medical Association, Dr Jaipal Chhabria, held the Sindh government responsible for the alarming situation, saying that incumbent politicians and senior government officials are least bothered about improving the situation.
“Despite the utilisation of billions of rupees and ever-increasing number of infant and child deaths, there has been no significant improvement in the district,” Dr Chhabria lamented. “It is due to the general mismanagement and appointment of incompetent officers in positions of authority against merit,” he added.
When approached, Sindh Nutrition Support Programme Manager Dr Waqar Memon refrained from commenting on the issue, saying that he cannot speak without obtaining the formal approval of higher government officials.
According to an official source in the Sindh Health Department, who spoke on the condition of anonymity, there has been an overall decrease in anaemia in the province. From 2018 to 2019, the number of anaemic children stood 47 per cent as compared to 61 per cent in 2011. However, wasting or low weight for height – which is a strong predictor of mortality among children under five – stood at 23.3 per cent between 2018 and 2019 as compared to 17.5 per cent in 2011.
Moreover, as per the National Nutrition Survey 2018, at present, Tharparkar district is experiencing the highest rate of wasting ever recorded in the country’s history. Despite improvements in socio-economic indicators, acute malnutrition continues to pose a nutrition emergency in the country.
Officials at the Health Department, on the other hand, claim that the province has achieved considerable improvement in reducing stunting among young children. According to official figures, stunting, which was recorded at 49.5 per cent in 2011, has reduced at 45.5 per cent in 2018 and 2019. However, according to the National Nutrition Survey 2018, it is still significantly higher.
“The prevalence of stunting among young children in Sindh, Balochistan, K-P and Gilgit Baltistan is higher than the national average,” states the National Nutrition Survey 2018. According to the survey report, the average annual reduction rate is estimated to be 0.5 per cent, which is too slow to significantly reduce the overall stunting rate in Pakistan.
The Sindh government, under the Priority Action Framework for Nutrition, has set a target of bringing down stunting to 30 per cent by 2021. As per the last Multiple Indicators Survey, Sindh’s malnutrition and micronutrient deficiency levels were above the threshold of serious public health problem, with wasting standing at 15.4 per cent and stunting at 48 per cent. What was more concerning was that vitamin A deficiency and anaemia among children under five were at 53 per cent and 73 per cent, respectively, with the latter about 10 per cent above the national average.
Ongoing nutrition programmes
Currently, there are different nutrition programmes underway in Sindh, which are worth billions of rupees. Several of the programmes have been running with the support of international donor agencies including the World Bank. These include the Sindh-Multi Action for Nutrition Project and the Sindh Enhancing Response to Reduce Stunting Project, among others.
According to the recent estimates of the United Nations Food and Agriculture Organisation (FAO), 37.5 million people in Pakistan still do not receive proper nutrition. While the country is food self-sufficient, 68 per cent of households cannot afford a stable-adjusted nutritious diet. Pakistan ranks 147th out of 188 countries on the 2015 United National Development Programme’s (UNDP) Human Development Index. Per the indicators, Pakistan is below the regional average for South Asia.
“Pakistan is not performing well in terms of improving health and nutrition outcomes or services, especially for the poor. Only Afghanistan has worse maternal and child mortality indicators in South Asia”, a World Bank report stated.
Published in The Express Tribune, October 23rd, 2019.